Abstract:

Background Information: Tanzania National Health Insurance Fund (NHIF) introduced various packages to increase enrollment from the informal sector. However, there is a lack of studies assessing the satisfaction with these packages by the informal sector as they access health care. This study assessed the satisfaction levels and the factors influencing satisfaction with NHIF packages utilized by informal insured clients at the selected accredited public and private health facilities in Mwanza City Council, Tanzania.

Methods: A descriptive cross-sectional study was conducted in 9 randomly selected public and private health facilities. 563 adult clients from the informal sector were interviewed as they entered and exited the health facilities. The data was analyzed using SPSS version 26, and client satisfaction was assessed using the SERVQUAL model, which compares client expectations to their satisfaction regarding service quality. The difference between the satisfaction percentage and expectation percentage, known as the total gap score, indicated patient satisfaction with NHIF packages. Paired sample t-tests were used to compare patient expectations and satisfaction between facilities, and bivariate and multivariate logistic regression were employed to examine the association between satisfaction (dependent variable) and independent variables.

Results: The study's results indicate a significant dissatisfaction rate (80.1%) among NHIF package beneficiaries, encompassing both public and private healthcare settings. Several factors including facility level, ownership, gender, education, perceived benefits, facility layout, drug availability, and provider responsiveness were linked to satisfaction levels. Surprisingly, more than half of the participants (55.6%) expressed a willingness to recommend and repurchase NHIF packages (54.5%) despite their discontent. This finding underscores an opportunity for the government to boost enrollment through policy adjustments, advocacy, and healthcare insurance education. Additionally, it suggests the potential for continued healthcare access even in cases of dissatisfaction, emphasizing the need to address these issues to improve patient satisfaction and fortify the healthcare system's effectiveness.

Conclusion: This study adds to the existing knowledge on patient satisfaction within Tanzania's NHIF context, emphasizing the need for ongoing, in-depth research to monitor satisfaction changes and assess the impact of NHIF reforms.